Urology Coding Alert

During some prolapse repair procedures, the urologist will add mesh to strengthen the repair. In some cases, you can report the mesh insertion separately, but in others you cannot. Knowing which procedures allow the additional mesh procedure coding can bring in additional reimbursement for each repair procedure as long as the physician documented medical necessity for the mesh.

When allowed, you should report the mesh insertion using +57267 (Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site [anterior, posterior compartment], vaginal approach [List separately in  additional to code for primary procedure]), says Nicole Martin, CPC, owner of Innovative Coding Analysis in Coplay, Pa. This add-on code requires no modifier or fee reduction.

Add-on code +57267 didn't change in 2009, but the parenthetical note following the descriptor did. It now states, "Use 57267 in conjunction with 45560, 57240-57265, 57285."

Example: A patient has a lateral cystocele that requires repair (57285). The native tissue (pubocervical fascia), however, is weak and will not hold sutures. Therefore, the physician elects to shore up the repair by using the mesh (+57267). In 2008 you could not report the mesh placement with a paravaginal repair, but in 2009, you can.

Caveat: Make sure the urologist's documentation supports medical necessity for the mesh insertion before reporting +57267. This means that the physician has documented the presence of weakened or attenuated rectovaginal or pubocervical tissue.

Good news: That's an additional $260.76 (7.23 RVUs times the 2009 conversion factor of $36.0666) your practice can recoup.

Tip: Remember +57267 is an add-on code, so you cannot report this code on its own. Always bill this service with another primary code.

You can report the addition of mesh using +57267 with the following primary codes: 45560 (Repair of rectocele [separate procedure]), 57240 (Anterior colporrhaphy, repair of cystocele with or without repair of  urethrocele), 57250 (Posterior colporrhaphy, repair of rectocele with or without perineorrhaphy), 57260 (Combined anteroposterior colporrhaphy), 57265 (... with enterocele repair), and 57285 (Paravaginal defect repair [including repair of cystocele, if performed]; vaginal approach). Also remember that because the code is an add-on code, do not append modifier 51 (Multiple procedures) to +57267 or reduce the fee you're charging for the procedure.